HomeMy WebLinkAboutMoisa (2) OFFICE OF THE TOWN CLERK ' •�.�FRj](K
Town of Southold 0� y �CDG
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o :t
P. O. Box 1179 w '�
Southold, New York 11971 O ��
Telephone *t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 60 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool XX
•
NAME OF OWNER: Henry F. and Helen A. Moisa
OWNER MAILING ADDRESS: RFD #47, Main Road
Orient, New York 11957
-OWNER PROPERTY-=ADDRESS-: —Main--Road
Orient, New York
OWNER TELEPHONE NUMBER: 516-323-3611
TAX MAP NO. : Section 14 Block 2 Lot 16
CROSS STREET: Old Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 29, 1986
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Southold Town CI
DATE: September 23, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold �o CQG'_, Application No. 6
Judith T. Terry, Town Clerk ``i Residential
Town Hall, 53095 Main Road c .. s . .
P. O. Box 1179 3 , '� �: Non-Residential
Southold, New York 11971 % ' ® ``'f �•'
_�%. . . Off- �•
Telephone �( �►�;
(516) 765-1801
TOWN OF SOUTHOLD
RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
SEP 23 1986 APPLICATION
rriwn Clerk Southold
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /4 °=
DATE a..57 2 1 /9
OWNER NAME: /7/pAiigy •=c9,./.4,/e,,v. .6Ap4
OWNER MAILING ADDRESS: ��
Coli/e/r7: /d r ¢ //9c7
OWNER PROPERTY ADDRESS: 41.11
OWNER TELEPHONE NUMBER: 5-n - R2.-x .F6 /(
TAX MAP NO. : Section /X'
Block 2- Lot //
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool L New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ? OW.
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
nature of Applicant
RECEIVED BY: a,
I Town clerk's ffice
DATE: l� (P�'(� 0 a23f /9P
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